Differential effects of adiposity on pharmacodynamics of basal insulins NPH, glargine, and detemir in type 2 diabetes mellitus. Diabetes Care 34:2521–2523. ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. 85 M. Whyte et al. De

OBJECTIVEdTo assess the role of adiposity on the pharmacodynamics of basal insu-lins NPH, detemir, and glargine in type 2 diabetes mellitus (T2DM), as estimated by glu-cose infusion rate (GIR) and endogenous glucose production (EGP) rate in the euglycemic clamp. RESEARCHDESIGNANDMETHODSdWe examined the variables that best predicted GIR and EGP in 32-h clamp studies after treatment with subcutaneous injection of 0.4 units/kg NPH, detemir, and glargine in 18 T2DM subjects (crossover). RESULTSdA multiple regression analysis revealed that BMI best predicted GIR variation during the clamp. BMI was inversely correlated with GIR in all three insulin treatments, but was statistically significant in detemir treatment only. BMI correlated positively with residual suppression of EGP in detemir, but not with glargine and NPH treatments. CONCLUSIONSdAdiposity blunts the pharmacodynamics of all basal insulins in T2DM. However, as adiposity increases, the effect of detemir is lower versus NPH and glargine. Diabetes Care 34:2521–2523, 2011 W e have shown that the phar-macokinetics and pharmaco-dynamics (PD) of basal insulin